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Context: COVID-19 induces complex distress across physical, psychological, and social realms and palliative care (PC) has the potential to mitigate this suffering significantly., Objectives: To describe the clinical characteristics and outcomes of COVID-19 patients with an indication of PC, compared to patients who had no indication, in different pandemic waves., Methods: This retrospective multicenter observational cohort included patients from 40 hospitals, admitted from March 2020 to August 2022. Patients who had an indication of palliative care (PC) described in their medical records were included in the palliative care group (PCG), while those who had no such indication in their medical records were allocated to the non-palliative care group (NPCG)., Results: Out of 21,158 patients, only 6.7% had indication for PC registered in their medical records. The PCG was older, had a higher frequency of comorbidities, exhibited higher frailty, and had a higher prevalence of clinical complications and mortality (81.4% vs. 17.7%, p  < 0.001), when compared to the NPCG. Regarding artificial life support, the PCG had a higher frequency of dialysis (20.4% vs. 10.1%, p < 0.001), invasive mechanical ventilation (48.2% vs. 26.0%, p < 0.001) and admission to the intensive care unit (53.6% vs. 35.4%, p < 0.001). These differences were consistent across all three waves., Conclusion: A low proportion of patients received PC. Patients in PCG were more fragile, had more clinical complications, and had a higher mortality. On the contrary to our expectations, they received more artificial life support in all three waves. Taken together, these findings suggest that decisions regarding PC indication were made too late, within a context of end-of-life and therapeutic failure., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Andrade, Luz, Oliveira, Kopittke, Santa Rosa, Gomes, Bartolazzi, Francisco, Costa, Jorge, Cimini, Carneiro, Ruschel, Schwarzbold, Ponce, Ferreira, Guimarães Júnior, Silveira, Aranha, Carvalho, Godoy, Viana, Hirakata, Bicalho and Marcolino.)

Background: Predicting the need for invasive mechanical ventilation (IMV) is important for the allocation of human and technological resources, improvement of surveillance, and use of effective therapeutic measures. This study aimed (i) to assess whether the ABC 2 -SPH score is able to predict the receipt of IMV in COVID-19 patients; (ii) to compare its performance with other existing scores; (iii) to perform score recalibration, and to assess whether recalibration improved prediction., Methods: Retrospective observational cohort, which included adult laboratory-confirmed COVID-19 patients admitted in 32 hospitals, from 14 Brazilian cities. This study was conducted in two stages: (i) for the assessment of the ABC 2 -SPH score and comparison with other available scores, patients hospitalized from July 31, 2020, to March 31, 2022, were included; (ii) for ABC 2 -SPH score recalibration and also comparison with other existing scores, patients admitted from January 1, 2021, to March 31, 2022, were enrolled. For both steps, the area under the receiving operator characteristic score (AUROC) was calculated for all scores, while a calibration plot was assessed only for the ABC 2 -SPH score. Comparisons between ABC 2 -SPH and the other scores followed the Delong Test recommendations. Logistic recalibration methods were used to improve results and adapt to the studied sample., Results: Overall, 9,350 patients were included in the study, the median age was 58.5 (IQR 47.0-69.0) years old, and 45.4% were women. Of those, 33.5% were admitted to the ICU, 25.2% received IMV, and 17.8% died. The ABC 2 -SPH score showed a significantly greater discriminatory capacity, than the CURB-65, STSS, and SUM scores, with potentialized results when we consider only patients younger than 80 years old (AUROC 0.714 [95% CI 0.698-0.731]). Thus, after the ABC 2 -SPH score recalibration, we observed improvements in calibration (slope = 1.135, intercept = 0.242) and overall performance (Brier score = 0.127)., Conclusion: The ABC 2 -SPHr risk score demonstrated a good performance to predict the need for mechanical ventilation in COVID-19 hospitalized patients under 80 years of age., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Cimini, Delfino-Pereira, Pires, Ramos, Gomes, Jorge, Fagundes, Garcia, Pessoa, de Carvalho, Ponce, Rios, Anschau, Vigil, Bartolazzi, Grizende, Vietta, Goedert, Nascimento, Vianna, Vasconcelos, Alvarenga, Chatkin, Machado Rugolo, Ruschel, Zandoná, Menezes, Castro, Souza, Carneiro, Bicalho, Cunha, Sacioto, Lutkmeier, Oliveira, Andrade, Menezes, Ribeiro and Marcolino.)

Objectives: To assess the ABC 2 -SPH score in predicting COVID-19 in-hospital mortality, during intensive care unit (ICU) admission, and to compare its performance with other scores (SOFA, SAPS-3, NEWS2, 4C Mortality Score, SOARS, CURB-65, modified CHA2DS2-VASc, and a novel severity score)., Materials and Methods: Consecutive patients (≥ 18 years) with laboratory-confirmed COVID-19 admitted to ICUs of 25 hospitals, located in 17 Brazilian cities, from October 2020 to March 2022, were included. Overall performance of the scores was evaluated using the Brier score. ABC 2 -SPH was used as the reference score, and comparisons between ABC 2 -SPH and the other scores were performed by using the Bonferroni method of correction. The primary outcome was in-hospital mortality., Results: ABC 2 -SPH had an area under the curve of 0.716 (95% CI 0.693-0.738), significantly higher than CURB-65, SOFA, NEWS2, SOARS, and modified CHA2DS2-VASc scores. There was no statistically significant difference between ABC 2 -SPH and SAPS-3, 4C Mortality Score, and the novel severity score., Conclusion: ABC 2 -SPH was superior to other risk scores, but it still did not demonstrate an excellent predictive ability for mortality in critically ill COVID-19 patients. Our results indicate the need to develop a new score, for this subset of patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Nogueira, Nobre, Pires, Ramos, Ribeiro, Aguiar, Vigil, Gomes, Santos, Miranda, Durães, Costa, Schwarzbold, Gomes, Pessoa, Matos, Cimini, Carvalho, Ponce, Manenti, Cenci, Anschau, Costa, Nascimento, Bartolazzi, Grizende, Vianna, Nepomuceno, Ruschel, Zandoná, Castro, Souza, Carneiro, Bicalho, Vilaça, Bonardi, Oliveira, Lutkmeier, Francisco, Araújo, Delfino-Pereira and Marcolino.)